Prescriptions for Pain List

THE PROBLEM OF PAIN

C.S. Lewis, the famous author and Christian apologist, once wrote an essay entitled 'The Problem of Pain.' His approach was a philosophical one. I, however, am not a philosopher, but a pharmacist. His approach was to grapple with the existence of pain, my approach is to grapple with the treatmentof pain. Regardless of how one approaches the 'problem' of pain, it is clear from any angle that pain IS a problem. Dr. Kathryn Weiner, the director of the American Academy of Pain Management, describes our national chronic pain situation as "silent epidemic" effecting upwards of 50 million Americans.

"Pain" treatment is a broad category. For the purposes of this article I will be focusing primarily on the prescription narcotic pain relievers available at a retail pharmacy which are used to treat a variety of "pain" conditions which include, but are not limited to:

Cancer Pain

Chronic Back Pain

Surgical Pain

The goal of this article is (1) to provide a resource for those currently looking for options to treat their pain, and (2) provide information for those looking to understand a little more about the particular pain medication which has been prescribed for them.

Many drugs have been developed to treat very specific painful conditions, and are generally limited to those conditions. Fore example, the injectable biological drugs like Enbrel for rheumatoid arthritis or the oral drug allopurinol for gout. These specific types of pain relievers are beyond the scope of this article. Click this link for an article specifically on the prescription drugs for Migraine Headaches which I have written.

For the sake of convenience and organization, I will divide and discuss these Prescriptions for Pain under 3 categories:

Long Acting Narcotic Prescriptions for Pain

Short Acting Narcotic Prescriptions for Pain

Non-Narcotic Prescriptions for Pain

LONG ACTING NARCOTICS FOR PAIN

Long-acting narcotic prescriptions are an important weapon in our war against against pain. They allow for once or twice daily dosing, as opposed to taking tablets every 3-4 hours. These prescriptions for pain are generally used to treat chronic conditions like cancer or injuries that will require an extended recovery time. As a general rule, long-acting products should never be crushed, broken or chewed. They must be swallowed whole.

I will group these by their active ingredient of: (1) Oxycodone, (2) Morphine, (3) Fentanyl, or (4) Methadone.

(1) OXYCODONE containing products:

Oxycontin (currently not available as a generic, Schedule 2 controlled substance). Oxycontin tablets come in a variety of strengths and are taken every 12 hours.

(2) MORPHINE (or morphine-like) containing products:

Avinza (Schedule 2 controlled substance). Avinza is an extended release form of morphine in capsule form available in a variety of strengths. They may be swallowed whole, or opened an sprinkled on applesauce. They must not be crushed, chewed or dissolved. Full prescribing information is available by clicking HERE.

MS Contin (Schedule 2 controlled substance). MS Contin is a 12-hour release (taken twice daily) form of morphine and comes in a variety of strengths and is available generically.

Opana ER (oxymorphone, Schedule 2 controlled substance). Opana ER is available as a tablet, and comes in a variety of strengths. Oxymorphone is a more potent form of morphine. Patients on morphine will likely require much smaller dosages of oxymorphone for comparable effects. Opana lasts 12 hours and is therefore dosed twice daily. For more information on Opana ER click HERE.

Oramorph SR (Schedule 2 controlled substance). Oramorph SR uses a unique mechanism to slowly release morphine into the body over 12 hours. Oramorph SR comes in several strengths and is manufactured by Xanodyne pharmaceuticals in Cincinnati.

Kadian (Schedule 2 controlled substance). Kadian is a slowly released morphine capsule designed to be taken once or twice daily. The capsules can be opened, and the contents sprinkled on applesauce, but the pellets must not be chewed or dissolved. For information on financial assistance for Kadian click here.

Embeda (Schedule 2 controlled substance). Embeda is a unique product containing morphine in an extended release tablet. Embeda ALSO contains a substance known as "naltrexone." The purpose of the naltrexone is to prevent Embeda from being abused by those who may be tempted to crush it, chew it, dissolve it...in order to get a "high" from the morphine content. If altered, the naltrexone is released and will produce very uncomfortable withdrawl symptoms. For more information on "naltrexone" read THIS ARTICLE.

(3) FENTANYL containing products:

Duragesic (Schedule 2 controlled substance). Duragesic is a patch containing fentanyl and is applied topically to the skin. The patch is designed to release the medication steadily over 3 days (72 hours). After 3 days the patch is to be removed, properly disposed of, and a new patch is applied (altering locations to avoid the development of skin irritation or a rash). Duragesic is available in a generic formulation. For information on Duragesic click HERE.

(4) METHADONE containing products:

Methadone: (Schedule 2 controlled substance). Methadone tablets come generically and in a variety of brand name forms such as Methadose and Dolophine. Methadone is generally dosed every 6 to 8 hours. Methadone is an effective pain reliever, but carries significant risks related to toxicity. For example, the following warning is attached to the prescription drug Dolohone: "Deaths, cardiac and respiratory, have been reported during initiation and conversion of pain patients to methadone treatment from treatment with other opioid agonists." This is serious medication! It must be used very carefully. For some statistics on the rising use of Methadone across the country, click HERE.

For an academic article, written by medical professionals, reviewing the uses of Methadone Treatment for pain CLICK HERE.

SHORT ACTING NARCOTICS FOR PAIN

Short acting narcotics generally are taken every 2-4 hours. They are commonly used for pain conditions that do not require 24 hour pain control, for relief of temporary or short-term pain, or to treat "break through" pain (pain experienced while currently being treated with other long-acting pain relievers, generally in between doses). There are many short acting narcotic pain relievers on the market. Some contain just a single ingredient (like morphine or oxycodone) and some contain two ingredients (like Percocet which contains oxycodone and acetaminophen). Because this is such an extensive category, I am simply going to list some of the many options available. I will list the ingredients next to the brand name, indicate if it is available generically, and provide website links to more information where it is available.

SINGLE INGREDIENT SHORT ACTING NARCOTICS:

Actiq (fentanyl oral lozenges, available generically): Actique has a unique delivery system. Fentanyl is basically sucked and absorbed through the cheeck and gums from the end of the delivery stick. Actique is ONLY prescribed for breakthrough pain in patients currently being treated with other opioids for pain. Click HERE for an explanation of how to use Actique.

NON-NARCOTIC PRESCRIPTIONS FOR PAIN

Effective pain relief IS possible without narcotic ingredients. Below I will list several prescription products currently being used to treat a variety of painful conditions that do NOT contain any narcotic ingredients.

Celebrex (celecoxib): Celexbrex belongs to a family called "NSAIDs" which stands for Non-Steroidal Anti-inflammatory Drugs. Celebrex has a lower incidence of stomach related side-effects than other NSAIDs. Celebrex is approved for the treatment of arthritis and comes in 50mg, 100mg, 200mg and 400mg capsules. Celebrex is dosed once or twice daily.

Lidoderm patches ( 5% lidocaine): Lidoderm patches are applied topically for 12 hours and then removed for 12 hours. Lidoderm is FDA approved for the treatment of pain due to shingles (known as post-herpetic neuralgia).

Ryzolt (tramadol extended release tablets): Ryzolt is an extended release form of tramadol which comes in 100mg, 200mg, and 300mg tablets. This product is taken once daily and should not be crushed or chewed. The most common side-effects of Ryzolt are nasea, constipation and dizziness. Ryxolt is NOT available generically.

Voltaren gel (1% diclofenac gel): Voltaren gel is approved for arthritis pain and is applied 4 times daily to the affected areas. The gel should be measured out with the dosing cards supplied.

A Note about Narcotics and Substance Abuse

Narcotic drugs, according to the DEA (Drug Enforcement Administration), are those medications which are derived from specific plant species or are derivatives of specific chemical substances which have the potential for addiction or abuse. For these reasons, some patients are reluctant to take narcotic pain relievers, and some physicians are reluctant to prescribe them. These are reasonable concerns. Here are a few thoughts to bear in mind:

Some narcotics have a higher potential for addiction and abuse than others. The DEA assigns them a "controlled substance schedule" to indicate those products with a greater or lesser degree of potential for dependence, addiction or abuse. Schedule 2 drugs (such as Oxycontin or Duragesic) have the highest potential for these problems. Drugs in schedules 3, 4 or 5 have a relatively lesser potential.

It is very important to follow the dosing schedule prescribed by your doctor. Make sure you discuss this with your doctor and that you clearly understand how to take this medication. Never take more than has been prescribed without express authorization from your doctor.

Never share your pain medication with someone else. These medications are strong, and can be harmful to others for whom they were not prescribed.

After proloned use, never stop your medication abruptly. Your doctor will generally work out a tapering approach so that your body adjusts to not having this medication.

Never take additional, non-prescribed, pain medication along with your narcotics unless specifically instructed to do so. Often prescription narcotics contain tylenol (acetaminophen) or ibuprofen, which is also available over-the-counter, and could be harmful if overdose.

ADDITIONAL RESOURCES FOR PAIN MANAGEMENT

It would be impossible to provide, in the space of a short article, a comprehensive list of all the medications used to treat pain. I hope this summary has provided some basic information to help you. Here are some links to other helpful articles on the subject of pain management:

Comments

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sending

Author

Jason Poquette 4 years agofrom Whitinsville, MA

spine problem,

Get a printout of your pharmacy records from your pharmacy. That should be proof enough.

spine problem 4 years ago

I had an md that had me on oxicodone 15mg because of chronic back pain and migraines it was the only thing that helped. Unfortunately my md passed away unexpected. It took me forever to find a new doctor so I stayed dealing with the pain for months. My new md how ever can not reach the old facility for proof..how should I go about getting my new md to get me back to my relief? He gave me Percocet 5/325 and the Tylenol messes with my ulcerative colitus.

Author

Jason Poquette 5 years agofrom Whitinsville, MA

docmopar,

Thank you kindly for sharing. I'm sure many patients can connect with what you are saying.

docmopar 5 years ago

I was badly injured 36 year, at age 23. Since then I have had many surgeries, and taken many narcotics. Most every one was worse than the benefits. Then 17 years ago, at the end of my sanity, I went to a pain specialist. I explained that the only relief I ever got was when I was hospitalized and dosed with morphine. She started me on a morphine regiment and it changed my life. I do not get a high. My pain is masked enough to make me able to get around and have a semi normal life. Any drug can be abused, and morphine is one of the worst, but after all these years, not a single sign of use or abuse. My friends and family don't even know I take it unless I tell them. I have a pump implant that doses it around the clock, so no waves of high and low. How many of you have a similar story ???

drag 5 years ago

I like dragons!

Author

Jason Poquette 5 years agofrom Whitinsville, MA

Daughter of Maat,

Yes, voltaren gel is cool stuff, and many benefit from it. Personally, I'm glad it is commercially available, as I don't have to compound it from scratch any more! Thanks and best wishes!

Author

Jason Poquette 5 years agofrom Whitinsville, MA

TahoeDoc,

Thanks for reading and for the kind words! Looking forward to reading some of your work now. Very nice to "meet" you :)

Melissa Flagg COA OSC 5 years agofrom Rural Central Florida

I take tramadol, robaxin and when I really need it I use voltaren gel. That stuff is AWESOME!! Ironically, it really doesn't smell all that bad!

Like all of your hubs this one was so informative. Had to share it.

TahoeDoc 5 years agofrom Lake Tahoe, California

Wow! Great, well-organized hub with excellent information! Shared with my followers. This is where people should get information on these medications if they are prescribed to them.

Author

Jason Poquette 5 years agofrom Whitinsville, MA

Lisa,

I am very sorry for your pain and the struggles you have had trying to get some relief. It sounds like what you need is a "non oral" form of breakthrough pain relief. It would be impossible to list all the possibilities, and I do not know your case well enough to know if these are appropriate. But there are nasal and injectable drugs for migraines (e.g. Imitrex, Zomig, Migranal) and there are other new nasal pain relievers like Sprix (non-narcotic - but very strong). Best wishes.

xldax33178 5 years ago

I have had a migraine headache for 7 years nonstop! The pain fluctuates but never goes below a 5 or 6 on the pain scale. This pain has left me disabled it is so bad all the doctors and specialist cant break the cycle nor do they know what to do for me!

The doctor that I am seeing now is really trying to keep me comfortable till the specialists can figure out what to do for longterm treatment.

My only problem is that with the migraine the nausea and vomiting doesn't help when I take a pill, I vomit it up within a few minutes. My doctor has given me a fentanyl patch for the long term pain management (it helps a lot) he also put me on Zofran that melts under my tongue and it helps with the nausea but im still vomiting everything and anything I eat. My doctor also put me on roxicodone for breakthrough pain and lorazepam to help relax me and my muscles because the pain makes me tense up. But both the roxicodone and lorazepam are in pill form and again I vomit the medication up even with the zofran!

I asked him about buccal fentora but he said that it was only used for cancer patients. What can I do? (I can't be the only one in this situation)

If you have any ideas that I can ask or discuss with my doctor please let me know ASAP!

I thankyou very much for taking the time to read this and would appreciate any suggestions you may have for me.

Appreciated that you classified short-acting narcotics by single ingredient and two ingredients. Tylenol and ibuprofen can be very toxic if not used correctly, but don't they also have dangerous side effects even if correct dosages are taken for a long period of time for chronic pain patients? I know that I can no longer take NSAIDS of any kind. Is there a single ingredient formula similar to Norco?

Author

Jason Poquette 7 years agofrom Whitinsville, MA

Hi Chris,

I don't have personal experience with this combination, but since Methadone is an analgesic, I can see how it might make sense. Sometimes long-acting produts are used for treating chronic pain, with a prescription for a short acting product (like Methadone) used to treat "break through" pain. I encourage you to look into this with your doctor. Best wishes.

Chris 7 years ago

Have you heard of a patient with severe chronic pain being treated with morphine and methadone at the same time but at different dose levels. I have taken oxycotin and am needing to switch. I have not gotten good relief since becoming disabled from either. A friend told me that is how her doctor treated her with the same issue I have had. She has good success with it. Thanks

Author

Jason Poquette 7 years agofrom Whitinsville, MA

C Hoss,

Hi! I added a brief statement about Embeda to the "morphine" category above. It is basically just long-acting morphine, but physicians will use it in patients for whom addiction and/or medication abuse might become a problem. Otherwise it really is no better for pain than the other traditional morphine products (e.g. MS Contin). Thanks for a great question!

C Hoss 7 years agofrom Kansas

can you tell me anything about embeda?

Author

Jason Poquette 7 years agofrom Whitinsville, MA

Hi JTrempe,

Very good advice and thanks for reading and commenting. I am a big fan of PT as well as many other forms of therapy for pain. I tend to write about the pharmacy/medicine side though...since that is my area of training. Always glad to have your input!! Thank you!

JTrempe 7 years agofrom CA, USA

It is interesting to hear a pharmacists view. We all come from a certain perspective. As a physical therapist I know the benefits of medication. Yet, all too often that is where pain management begins and ends. There is great research about the benefits of exercise and chronic pain reduction. Getting the body moving helps to stimulate the natural pain relievers in our bodies. So, consider including exercise into your pain management program.

For more information and treatment recommendations for common joint pain conditions, visit: